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INSTRUCTIONS: Please attached a copy of the following to this form and email back to jgr.hcsi@gmail.com unless the
following has been emailed together with your resume.
1. Resume
2. Birth Certificate
3. NBI Clearance
REFERRED BY:
WORK SCHEDULE:
What date are you available to begin work?
Are you willing to work weekends and holidays?
NAME
SURNAME FIRST MIDDLE NICKNAME
CITY
ADDRESS NO. STREET DISTRICT CITY CONTACT NO.
PROVINCIAL ADDRESS
CONTACT NO.
BIRTH
DATE PLACE RELIGION
N
A
L
S
TIN: Pagibig ID #:
SSS #: Philhealth ID #
PROFESSION SALARY
ELEMENTARY
HIGH SCHOOL
COLLEGE
VOCATION
POST GRADUATE
K
G
O
N
A
A
C
U
N
D
L
GRADUATE EXAMINATION TAKEN: BAR ____ BOARD ___ CIVIL SERVICE___ NONE _______
IF SO, WHERE:
O
Y
A
C
U
N
D
B
Employer/ Company:
Name of Supervisor:
Starting Salary:
Last Salary:
Employer/ Company:
Name of Supervisor:
Starting Salary:
Last Salary:
M
O
N
R
Y
End Date:
E
Start Date:
S
I
Employer/ Company:
Name of Supervisor:
Starting Salary:
Last Salary:
Employer/ Company:
Name of Supervisor:
Starting Salary:
Last Salary:
If yes, why?
Give 5 references who know you well, who are not your relatives:
Full Name Employment Info/ Address Contact No.
A
C
R
R
N
C
T
E
E
F
S
How do you think your strengths can contribute to Hari-Raya?
A
Y
A
R
R
Y
E
S
I
I hereby authorize Hari-Raya Coffee Shops, Inc./ Hari-Raya Lounge & Business Center, Inc. to
thoroughly investigate my background, references, employment record, and other matters related to my
suitabiity for employment. I authorize persons, schools, my current employer (if applicable), and
previous employers and organizations contacted by Hari-Raya to provide any relevant information
regarding my current and/or previous employment and I release all persons, schools, employers of any
and all claims for providing such information. I understand that misrepresentation or omission of facts
may result in rejection of this application, or if hired, discipline-up to and including dismissal. I
understand that I may be required to sign a confidentiality and/or non-complete agreement, should I
become an employee of Hari-Raya Coffee Shops, Inc. or Hari-Raya Lounge & Business Center, Inc. I
understant that nothing contained in this application, or conveyed during any interview which may be
granted, is intended to create an employment contract. I understand that filing out this form does not
indicate that there is a position open and does not obligate Hari-Raya Coffee Shops, Inc. or Hari-Raya
Lounge & Business Center to hire me.